Healthcare Provider Details

I. General information

NPI: 1073485454
Provider Name (Legal Business Name): LUCRECIA TAINTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 NM-571
EL RITO NM
87530
US

IV. Provider business mailing address

PO BOX 488
EL RITO NM
87530-0488
US

V. Phone/Fax

Practice location:
  • Phone: 575-581-4728
  • Fax:
Mailing address:
  • Phone: 505-901-7023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number85765
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: